Background

Although a large proportion of patients with T2D experience initial remission some patients later suffer from relapse.ObjectivesTo identify possible risk factors for T2D recurrence in patients who initially experienced remission.SettingNationwide, registry-based

Methods

We conducted a nationwide registry-based retrospective cohort study including all adult patients with T2D and BMI >=35 kg/m2 who received primary bariatric surgery with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Sweden between 2007 and 2015. Patients who achieved complete diabetes remission 2 years after surgery was identified and analyzed. Main outcome was postoperative relapse of T2D, defined as reintroduction of diabetes medication.

Results

Complete T2D remission was achieved in 2090 patients 2 years after surgery. Mean age was 46.6 +- 10.10 years, mean BMI was 42.7 +- 5.83 kg/m2, proportion of women was 64.6% and mean HbA1c was 54.8 +- 16.0 mmol/mol at the time of surgery. This group was studied with a median follow-up time of 5.9 years after surgery with a cumulative T2D relapse incidence 20.1%. Duration of diabetes (hazard ratio [HR] 1.09 95%CI 1.05-1.14,p<0.001), preoperative HbA1c level (HR 1.01 95%CI 1.00-1.02,p=0.013), and preoperative insulin treatment (HR 2.67, 95%CI 1.84-3.90,p<0.001) were associated with higher rates for relapse, while postoperative weight-loss (HR 0.93, 95%CI 0.91-0.96, p<0.001), and male sex (HR 0.65, 95%CI 0.46-0.91,p=0.012) were associated with lower rates.

Conclusions

Longer duration of T2D, higher preoperative HbA1c level, less postoperative weight-loss, female sex and insulin treatment prior to surgery are risk factors for T2D relapse after initial remission.